Acute pain medicine: Organizing an acute pain medicine service

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N UMEROUS STUDIES illustrate that the majority of postsurgical patients recall moderate to severe pain during their hospital stay.l-4 In 1973, Marks and Sachar 2 reported a landmark investigation showing that 73% of patients receiving opioid analgesia suffered from moderate to severe distress for a multitude of reasons, including lack of sophistication regarding analgesic usage and exaggerated apprehension of the dangers of addiction. In response, the Agency for Health Care Policy and Research developed and published the Acute Pain Management: Operative or Medical Procedures and Trauma guidelines in 1992. 5 These guidelines were developed (1) to reduce the incidence and severity of acute postoperative and posttraumatic pain, (2) to educate patients about the need to communicate unrelieved pain so they can receive prompt evaluation and effective treatments, (3) to enhance patient comfort and satisfaction, and (4) to contribute to fewer postoperative complications and, in some cases, shorter hospital stays after surgical procedures. Despite these and other guidelines, acute pain continues to be a significant clinical problem. Anesthesia-based acute pain services (APSs) have evolved in response to this prevalent problem. First described by Ready et al 6 in 1988, an APS can improve postoperative analgesia in a safe and effective manner. This report will focus on the organization and benefits of a modem APS.